Radiation recall dermatitis L30.8 + T66

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 02.11.2023

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Synonym(s)

radatio-recall dermatitis; Radiation Recall Dermatitis; Radiatio Recall Dermatitis; Radio Recall; RRD

Definition
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Local inflammatory reaction of the previously irradiated skin areas after the start of a mostly cytostatic systemic therapy of an underlying tumor.

Etiopathogenesis
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Despite many case descriptions, the etiology remains unclear. Diverse hypotheses ranging from allergic reactions to degraded epithelial stem cells are propagated.

Manifestation
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The occurrence of RRD has been described in case reports following the use of chemotherapeutic agents (e.g., actinomycin D (dactinomycin), methotrexate, doxorubicin, gemcitabine, tamoxifen, and bleomycin), as well as antibiotics or tyrosine kinase inhibitors. Disease can occur within days, weeks to years after completion of radiotherapy. Intervals of a few minutes to 14 days have been described with intravenously administered drugs.

Localization
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The disease occurs exclusively in the irradiated areas.

Clinical features
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Chronic, extensive, usually itchy erythema or reddened plaques confined to a radiation field. Healing with scaling and patchy hypo- or hyperpigmentation. Severe courses with the formation of ulcerations have been described.

Histology
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The early phases of the inflammatory reaction are characterized by interface dermatitis and cannot be distinguished from acute radiation dermatitis.

Therapy
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Omission of the causally accused drug is recommended. A treatment with steroids and/or antihistamines is controversially discussed in the literature.

Note(s)
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Of note is the occurrence of radiation-recall morphea (Spalek M et al. 2015).

Methotrexate can triggerUV recall in a similar manner, although UV irradiation should not have occurred more than 5 days ago

In addition to the skin, other organs may be affected by radiatio-recall reactions (e.g.cardiac organ).

Literature
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  1. Bhangoo, R. S. et al (2022). Radiation recall dermatitis: A review of the literature. Seminars in Oncology, doi: 10.1053/j.seminoncol.2022.04.001.

  2. Clark E et al (2015) Chlorambucil-induced radiation recall dermatitis. Skinmed 13:317-319
  3. Delavan JA et al (2015) Gemcitabine-induced radiation recall myositis. Skeletal Radiol 44:451-455.
  4. Haraldsdottir S et al (2016) Radiation Recall Dermatitis With Concomitant Dabrafenib and Pazopanib Therapy. JAMA Dermatol doi: 10.1001/jamadermatol.2015.5366
  5. Kandemir EG et al (2005) Docetaxel-induced radiation recall dermatitis. Swiss med Wkly 135: 35-35
  6. Kim G et al (2017) Radiation recall dermatitis triggered by sorafenib after radiation therapy for hepatocellular carcinoma. Radiation oncology journal 35:289-294.

  7. Prindaville B et al (2016) Radiation recall dermatitis secondary to dactinomycin. Pediatr Dermatol 33:e278-279.
  8. Putnik K et al (2006) Enhanced radiation sensitivity and radiation recall dermatitis (RRD) after hypericin therapy - case report and review of literature. Radiat Oncol 1: 32-37
  9. Spalek M et al (2015) Radiation-induced morphea - a literature review. J Eur Acad Dermatol Venereol 29:197-202.

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 02.11.2023